Patient Presentation
A 30-year-old patient reported with a complaint of food lodgment and pus discharge in the lower right back tooth region for the past 2–3 days.
On history taking, it was revealed that a filling was done in tooth 48 around 2 years back. The patient did not have any significant medical history.
On clinical examination, tenderness and discharge were noted in relation to tooth 48. To confirm the diagnosis, an Orthopantomogram (OPG) was advised, which showed an impacted mandibular third molar (48).
Considering the symptoms and radiographic findings, extraction of 48 under local anesthesia was planned.
Diagnosis
- Chief Complaint: Food lodgment and pus discharge from lower right back tooth (48).
- Clinical Findings: Tenderness, discharge, previously restored tooth.
- Radiographic Findings: Impacted mandibular third molar (48).
- Final Diagnosis: Infected impacted mandibular right third molar (48).
- Treatment Performed: Surgical Extraction of 48
Step 1: Preparation & Anesthesia
- The procedure was carried out under strict aseptic precautions.
- Local anesthesia was administered: Inferior alveolar nerve block, lingual nerve block, and long buccal nerve block with 2% Lignocaine containing 1:80,000 adrenaline.
- Adequate anesthesia confirmed before starting surgery.
Step 2: Incision & Flap Reflection
- A standard Ward’s incision was placed, extending along the external oblique ridge with a relieving incision anterolaterally.
- A full-thickness mucoperiosteal flap was elevated carefully to expose the surgical site.
Step 3: Bone Removal
- Buccal bone overlying the crown and roots was removed using a straight surgical bur with continuous saline irrigation.
- Adequate bone guttering allowed proper access to the tooth.
Step 4: Tooth Extraction
- Tooth was luxated using elevators and delivered carefully to avoid damage to adjacent structures.
- Root pieces checked to ensure complete removal.
- Sharp bony margins smoothened with a bone file.
Step 5: Socket Care & Closure
- The extraction socket was irrigated thoroughly with sterile saline to remove debris and infection.
- Hemostasis achieved.
- The flap was repositioned and sutured using 3-0 black silk sutures.
Postoperative Care
- Cold compress for the first 24 hours to minimize swelling.
- Avoid spitting, rinsing, or hot food/drinks for the first 24 hours.
- Soft diet and proper hydration advised.
- Medications prescribed: Antibiotics, analgesics, and antiseptic mouth rinse.
- Follow-up scheduled after 7 days for suture removal and healing assessment.
Outcome
The patient tolerated the extraction procedure well. On follow-up, pus discharge had resolved and the extraction site showed satisfactory healing.
Discussion
Impacted wisdom teeth are highly prone to food impaction, secondary infection, and pus formation, even if they have been restored previously. Restorations in impacted molars often fail due to their position and difficulty in maintaining hygiene. In such cases, surgical extraction remains the definitive treatment to prevent recurrent infection, swelling, and damage to adjacent teeth.